Health and Wellbeing Services: Essex

Will Quince Excerpts

Tuesday 12th March 2024 Westminster Hall

[Will Quince (Colchester) (Con)]

It is a pleasure to serve under your chairmanship, Mr Henderson. I congratulate my right hon. Friend the Member for Witham (Priti Patel) on securing this important debate on health and wellbeing services in Essex. Her powerful speech raised a number of issues affecting all parts of Essex, including my own, in north Essex, and specifically Colchester. Understandably, I plan to focus on north Essex and my constituency, but given that I stood down as a Minister of State at the Department of Health and Social Care only in late November, I want to start with some reflections on our NHS more generally. May I say in passing that the Minister is doing a marvellous job with a difficult brief? As he knows, it is a privilege and an honour to be a Minister at the Department of Health and Social Care and to be part of our NHS’s story.

The NHS is a universal, comprehensive system that is free at the point of use and paid for through taxation—principles that remain intact and that receive strong public and political support today. At its heart, as my right hon. Friend the Member for Witham set out, the NHS is not about buildings and equipment—as important as those are, and we are of course passionate about health centres, hospitals and the latest technology—but about the circa 2 million people who work in it day in, day out to deliver and facilitate the high-quality care we rightly expect. I want to take this opportunity to thank everyone who works in our NHS, especially those working in north Essex and those serving patients and my constituents in Colchester.

We all have our personal experiences of our NHS and of the care that we and our families have received. When we think about the future of health and wellbeing services in Essex, we have to be mindful of the broader context, much of which my right hon. Friend set out in her powerful speech. Our NHS is under significant and considerable pressure and faces a number of challenges. We have increasing demand, particularly in primary care and in urgent and emergency care. We are living longer, which is brilliant, but it comes with challenges, including living with complex conditions and comorbidities.

Social care continues to be a challenge, especially around workforce, as my right hon. Friend set out. We have increasing demand on mental health services. We had the covid pandemic, with the backlog and the waiting lists, but also the resulting later diagnosis of cardiovascular disease and other conditions, as many people were unable to or did not come forward with symptoms or for regular check-ups.

We also have the at times seemingly intractable complexity of NHS structures and processes; the silo mentality that we sadly see so often; the multiple tiers and archaic processes; the challenges in rolling out the latest innovative technologies, such as tech, drugs, treatment and therapies, that are available in some parts of Essex or the country but not in others; and the issue of making sure that research and innovation is truly embedded in every single trust in the country.

That is not an exhaustive list, and I have not mentioned two of the biggest challenges—workforce and funding—one of which my right hon. Friend touched on in some detail. First, on funding, the NHS will always need increased funding to reflect the changing nature of medicine and the health needs of our population and, importantly, to ensure that we have the very latest and most innovative and cutting-edge medtech, treatments, drugs, procedures and therapies for our patients. Despite record revenue and capital budgets for our NHS, year-on-year real-terms increases in funding, and further significant funding—in fact, several billion pounds of funding—announced in the spring Budget, which I massively welcome, budgets remain a challenge for local systems and for trusts, not just in Essex but across the country.

Secondly, as my right hon. Friend pointed out, workforce is absolutely vital to our NHS, and she was right to mention the hugely important contribution that international staff make—they have contributed since its formation, and continue to do so. Regardless of the NHS long-term workforce plan, as important as it is, international recruitment will still have a hugely important role to play.

I was a Minister at the DHSC when the Government commissioned NHS England to produce the first ever NHS long-term workforce plan, which the Minister will no doubt elaborate on. The plan was then published, backed with £2.4 billion over the next five years by the Government. It included things like doubling medical school places, including at Anglia Ruskin University, which we are incredibly proud of; huge increases in nursing, midwifery and allied health professional training places; and a plan for retention—it is critical that it is about not just recruitment but retention and, of course, reform.

We talk about workforce and funding, but the truth is that addressing those two things alone will not tackle the challenges our NHS faces either nationally or locally. Only by innovating and transforming local systems and the delivery of health and care provision at a local level can we deliver on what we all aspire to across this House, which is our local populations living longer, healthier, happier and more fulfilling lives.

I firmly believe that integrated care systems, which my right hon. Friend touched on, are at the heart of achieving that. They are working holistically at a local level to get systems focusing relentlessly on patient outcomes and patient experiences, and breaking down the silo mentality that we have sadly so often seen in our NHS historically. Their other critical role is driving transformation and innovation at a local level, getting trusts and organisations to work together, and using all assets and capacity within health systems.

I pay tribute, as my right hon. Friend did, to the leadership of the Suffolk & North East Essex Integrated Care System—Dr Ed Garratt and his team. I know how closely they work with Nick Hulme and his team at the East Suffolk and North Essex NHS Foundation Trust or, as it is known locally, Colchester and Ipswich Hospitals. Our health system more broadly, and our two acute hospital trusts in north Essex and east Suffolk, face many of the challenges I set out earlier, but to their great credit, they are continuously looking at innovative ways to address them.

For example, our system in north Essex and east Suffolk is consistently one the highest and best-performing in the country. It had the fastest roll-out of the covid-19 vaccine. It is a top performer for diabetes care. It has consistently low levels of delayed discharge, an issue my right hon. Friend the Minister and his fellow Minister, the Minister for Social Care, spent a lot of time focusing on, and rightly so, because of the continued pressure on urgent and emergency care and the importance of tackling delayed discharge.

Our local system has also led on innovation. It has developed the Care Tech Campus and the challenge fund, in particular, with the University of Essex and Essex County Council. My right hon. Friend the Member for Witham was right to praise the role that Councillors Kevin Bentley and John Spence have played in that, working in partnership with the health system to deliver innovation in care that is providing not just better outcomes, but a better experience for patients. Finally, our local system is leading the way on National Institute for Health and Care Research-funded research, which we want more trusts across the country to do.

Before I finish, I want to raise a handful of initiatives in north Essex and east Suffolk that I think deserve highlighting, because they are going to be transformational in terms of both patient experience and outcome. The first is the elective orthopaedic centre at Colchester Hospital, which I was fortunate enough to have a tour of recently. It is hugely exciting. It is an impressive £64 million facility serving north-east Essex and east Suffolk. It is the largest of its kind in Europe, at over 11,000 square metres, and will include eight theatres, three wards, a physio, a gym, a day surgery, a recovery centre and its own imaging department. Importantly—I know the Minister will be pleased to hear this—it will enable 10,000 procedures a year following its opening, which is due to take place this August.

The second initiative is the Clacton community diagnostic centre, in the constituency of my hon. Friend the Member for Clacton (Giles Watling). I am sorry he could not be here for the debate, but I want to reference it as it serves the wider area. The centre is a £25 million investment in state-of-the-art diagnostics, meaning that patients can access the full range of diagnostic services, including CT scans, MRI scans, X-rays, ultrasounds, blood scans and cardiorespiratory medicine. Importantly—I visited a lot of community diagnostic centres when I was in the Minister’s role—this facility has delivered more than 110,000 treatments in the past year. I would love it if the Minister could check this, but I think that it must be one of the highest performing centres—if not the highest performing centre—in the country.

I want to turn now to two mental health and mental resilience projects, which our integrated care system is leading on and which I think deserve a mention. The first is the north-east Essex mental health joint response vehicle, which was successfully commissioned as a three-year service following a successful pilot between January and March 2023. This unique service is a collaboration between the East of England Ambulance Service and the Essex Partnership University NHS Foundation Trust—our mental health trust—with a paramedic and mental health practitioner manning a 10-hour service seven days a week. That service has been so successful in ensuring that those experiencing a mental health crisis are seen by the most appropriate service. I am really keen that we extend those hours, and I know that the ICS is looking at securing additional funding to do so.

The data backs up why it is a good thing to do. In 2023, the joint response vehicle attended 757 patient calls for a variety of mental health-related presentations, including suicidal threat, self-harm, depression and psychosis, with 77% of patients being redirected to another service or provided with a care plan at home, reducing by 55% the number of attendances at emergency departments for mental health-related issues. I will not need to remind the Minister that mental health is not only one of the largest drivers of attendance at our emergency departments, especially involving conveyance via ambulance, but leads to some of the longest cubicle occupation in our emergency departments, as hospitals do not have the beds to move people up and into, and often takes up additional resource, such as police officers and others.

The second initiative I want to touch on involves primary school wellbeing hubs—these are more about mental resilience, but I think that that is an important area to highlight. When I was Schools Minister and Children’s Minister, we worked closely with the Department of Health and Social Care on investment in mental health resilience support with mental health support teams, on training for schools and on the support teams that would go into schools to provide that support.

The Tendring and Colchester wellbeing hubs are a pilot project with 22 primary schools in Colchester and Tendring, which aims to improve children’s mental health and wellbeing through a prevention and early intervention approach. This programme has delivered across 22 schools, with 19 of them completing a number of questionnaires that have been evaluated by the University of Essex to demonstrate the impact and evaluate the programme over the 12 months in which it has run.

Overall, pupils who attended the wellbeing hub sessions had significant increases in their levels of resilience, wellbeing and happiness and decreased anxiety. The initiative was supported by more than 80% of parents, who said that their children communicated better, while more than 60% of children said they had more confidence and were more resilient and less stressed or anxious. I know that such programmes are happening to varying degrees across the country, but our integrated care system is really leading the way and demonstrating things that could be replicated and rolled out to other parts of the country.

In conclusion, I thank again all those involved in the delivery of healthcare across north Essex, as well as the leadership of the Suffolk & North East Essex Integrated Care System and the East Suffolk and North Essex NHS Foundation Trust for driving the innovation and transformation of health and care provision locally. We know that that is the future of delivering not just better a patient experience, but better patient outcomes. I once again thank my right hon. Friend the Member for Witham for giving us the opportunity to talk about health and wellbeing services in Essex, which, as she rightly said, we all care so passionately about. We all know that the challenges both locally and nationally are significant, and we all want and expect world-class care for our constituents. I know that I and all my Essex colleagues will continue to work with our local NHS bodies in all their guises to support them to deliver it.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 5th March 2024 Commons Chamber

[Helen Whately]

I am very sorry to hear about what happened to the hon. Gentleman’s constituent. I send my condolences to her family and loved ones. Clearly, it is very important that discharge decisions are led by clinicians, who can make a clinical decision about whether somebody is medically ready to be discharged. I have no doubt that the family may well take up that decision with local NHS organisations.

[Will Quince (Colchester) (Con)]

No doctor wants to be on strike, so I welcome the new deal with the consultant unions. It shows that by being reasonable, pragmatic and acting in good faith, unions can deliver for their members. Does my right hon. Friend agree?

[Victoria Atkins]

My hon. Friend knows only too well the importance of industrial action and the impact it can have on patients and on the NHS as a whole. I am pleased that the BMA has announced today, following the previous settlement that was narrowly rejected in its ballot, that it has been able to get back around the table with my officials and me. We have been able to find a fair and reasonable settlement that the BMA will advocate for and recommend to its members. We hope that that shows those who are choosing to strike that constructive negotiations, and trying to sort out some of the concerns that we know clinicians have, can be dealt with in a reasonable manner, which is of benefit not just to staff, but to patients.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Helen Whately]

One reason we distributed discharge funding back in April last year was to give more advance notice to organisations, so that they could put in place what is needed to speed up discharges. I say to the hon. Lady that our plan is working. That is why, in her own trust, discharges at the end of December were down by a third compared with the previous year.

[Will Quince (Colchester) (Con)]

I note the progress that my hon. Friend referenced, but delayed discharges are still a major issue. Patient flow through a hospital is a critical factor, especially at the front door through emergency departments. We know the role that electronic bed management systems can play in helping that flow. What steps is my hon. Friend taking to ensure that more hospitals roll out that technology?

NHS Winter Update

Will Quince Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

I hope the hon. Gentleman will be interested to know that we have made cancer treatment waiting times a key focus of our elective recovery plan, which has been backed by an additional £8 billion in revenue funding across the spending review period. We have made progress by delivering record numbers of urgent cancer checks, with more than 2.9 million people seen in the 12 months to October last year. Of course there is more to do, and I would be very happy to meet him and colleagues across the House to discuss the practical ways by which treatment can reach our constituents. He will not be surprised to know that cancer is a priority not just for me personally, but for the Government as a whole.

[Will Quince (Colchester) (Con)]

I welcome my right hon. Friend’s statement; there is a lot in it to welcome, but I particularly welcome the additional 11,000 virtual ward beds. Hospital at home is hugely popular and we know it takes pressure off our hospital. I thank all of the clinicians who helped to make that possible. Can she confirm that it is her intention now to go further and roll it out to more hospitals and more specialties, so that more patients can recover at home?

[Victoria Atkins]

I thank my hon. Friend for all his work in making that happen. He worked very hard on virtual wards when he was a Health Minister, and they represent a real step change in how we treat people with long-term conditions who can be monitored safely at home. They mean that people do not have to spend time in hospital, with all the pressures that can mean for us as individuals. Importantly, that also frees up beds for other patients who need them. I am keen to roll the scheme out further. Indeed, we have not just met but exceeded our initial ambition, which is why I can confirm that we have delivered 11,000 places in the virtual bed ward category.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 5th December 2023 Commons Chamber

[Helen Whately]

The hon. Member is right that our hospitals are busier; we are seeing more patients in A&Es. That is why we are doing two things with our work on urgent and emergency care. One is providing more capacity—more hospital beds, more hours of ambulances on the road, and more capacity in social care to help with discharges. We are also doing things differently by seeing more people out of hospital, avoiding people coming to hospital unnecessarily, and providing more care at home; for instance, our 10,000 “hospital at home” beds are helping people recover at home, which is better for them and better for the system.

[Will Quince (Colchester) (Con)]

I know the considerable work the Department and NHS England have done preparing for winter. Given the importance of the NHS workforce, who do such an incredible job, and noting that there are still a few months to go, will the Minister update the House on the delivery of our manifesto commitment for an additional 50,000 nurses?

[Helen Whately]

I pay tribute to my hon. Friend for the excellent work he did as a Health Minister. It was a real pleasure to work alongside him and see what a difference he made for our constituents across the country. He asks a very good question about the work we are doing to increase the capacity of the NHS and ensure that it has the workforce it needs, including by delivering on our manifesto commitment to 50,000 more nurses for the NHS, which we have achieved.

Ambulance Services: Minimum Service Levels

Will Quince Excerpts

Wednesday 8th November 2023 Written Statements

[The Minister for Health and Secondary Care (Will Quince)]

The Government are focused on making the hard but necessary long-term decisions that are in the best interests of the country, to put the UK on the right path for the future. The Government’s priority is to ensure that when strike action takes place in the NHS, the safety of patients is protected as far as possible.



Minimum service levels are in place in a range of countries in Europe and beyond, as a way of balancing the ability of employees to strike with the needs of the public. The International Labour Organisation (an agency of the United Nations) recognises that this is justifiable for services where their interruption would endanger citizens’ life, personal safety or health. Disruption to ambulance services puts lives at immediate risk.



On 6 November 2023, the Government published the response to the consultation on “Minimum service levels in event of strike action: ambulance services in England, Scotland and Wales”. In it we confirmed that, subject to parliamentary approval, we will introduce regulations which set minimum service levels and cover the 10 NHS ambulance trusts in England, as well as the ambulance services provided by the Isle of Wight NHS Trust. While the UK Government think that people across the UK should be able to be confident about what types of situations the ambulance service will respond to on strike day, they recognise that responsibility for the operation of these services in Scotland and Wales lies with the devolved Administrations. We therefore intend for the regulations to apply to England only at this time, rather than also including Scotland and Wales.



The services included in the minimum service levels will be the 999 and healthcare professional (HCP) call handling and emergency ambulance response to those calls, inter-facility transfers (IFT) and non-emergency patient transport services (NEPTS). The overarching principle is that those cases that are life-threatening, and those for which there is no reasonable clinical alternative to an ambulance response, should receive a response as they would on a non-strike day. In the case of NEPTS, patients for whom there is no reasonable clinical alternative to the patient receiving health services on the strike day should have their transportation provided as they would on a non-strike day.



Our response to the consultation reaffirms our commitment to ensuring that patients can access ambulance services when they need them during a strike. We have laid regulations which will address the inconsistency and uncertainty of relying on the unions to agree arrangements on a case-by-case basis, by giving employers the power to issue work notices should they need to. This will increase public confidence in the service and better protect patient safety during periods of industrial action.



The Government will shortly lay a statutory code of practice in Parliament for approval on the reasonable steps trade unions should take in order to meet the legal requirements under the Act. This follows a commitment made during the passage of the Act through Parliament to bring forward such a code of practice and the recent conclusion of a public consultation on the draft code. Separate non-statutory guidance will also be published shortly on the issuing of work notices by employers, where the regulations apply, to secure minimum levels of service on strike days. The consultation response has been published on gov.uk. The Government wish to thank everybody who took the time to provide feedback as part of the consultation process.

[HCWS20]

Osteoporosis

Will Quince Excerpts

Thursday 26th October 2023 Commons Chamber

[The Minister for Health and Secondary Care (Will Quince)]

I commend the hon. Member for Bradford South (Judith Cummins) for bringing this issue to the House’s attention. As chair of the all-party parliamentary group on osteoporosis and bone health, she has long been a champion for those with osteoporosis. She will know that many of the points raised today echo arguments made in the other place only last month. As ever, she articulately and eloquently made a powerful and persuasive case, and I very much look forward to working with her and the charities that specialise in this area to improve service provision and support for those with osteoporosis.

As the hon. Lady set out in her speech, osteoporosis represents a growing challenge in this country as our demographics shift, particularly for older people. It is estimated that in the UK more than 3 million people have osteoporosis, including approximately one in 10 women aged 60 and one in five women aged 70, with more than 500,000 fragility fractures occurring each year. As she rightly pointed out, this silent disease does not just affect older people. Many people of working age suffer preventable fractures, with an estimated 2.6 million sick days taken every year in the UK due to osteoporotic fractures. Studies suggest that over 22% of the population aged 50 to 64 will suffer a fracture.

Impassioned calls have been made of late for increased Government support for FLS, both within Parliament, not least from the hon. Lady, and in the media. I thank colleagues across both Houses and the Sunday Express, which has led on this issue, for helping to raise the profile of these important services, which have long been recognised as best practice for secondary fracture prevention by both the Department of Health and Social Care and NHS England. Indeed, in our “Major Conditions Strategy: A case for change and strategic framework”, published this summer, we made it clear that we would continue to explore supporting the provision of FLS.

As the hon. Lady will know—indeed, she raised this in her speech—fracture liaison services are locally commissioned. My hon. Friend the Member for Southend West (Anna Firth) rightly pointed out, first in her intervention and then in her short speech, the importance of FLS. I thank her for drawing attention to and championing the service in Southend, which is an exemplar that we hope other integrated care boards will follow.

For local systems requesting support to review and improve their secondary fracture prevention pathways, NHS England is producing system-level data packs, which include data from a variety of sources. That includes the FLS database to highlight where there may be unwarranted variation; the impact of, and upon, existing health inequalities, which we should always be concerned about; and where there are opportunities for transformation. The Royal Osteoporosis Society outlines that, for every £1 spent on FLS in the UK, the taxpayer can expect to save £3.28. So by levelling up provision to cover everyone over the age of 50, we could prevent just under 5,700 fragility fractures every year. If that is the case, it is only right that NHS England continues to support ICBs to develop their secondary fracture prevention services. As the hon. Lady rightly pointed out, the benefits are clear and I trust that commissioners will be exploring how best to support the needs of their patients in this important area.

The major conditions strategy is not the only headline workstream that we are taking forward to improve osteoporosis care. The first ever Government-led “Women’s Health Strategy for England” was published in July 2022, marking a reset in the way in which the Government are looking at women’s health. As part of that work, we are investing £25 million in women’s health hubs, with each ICB set to receive £595,000 over the current and next financial year to establish a women’s health hub within their system. As we have outlined in the women’s health hubs core specification, specific services will vary depending on population health needs, the existing set-up of services and the workforce skills in a local area. The core specification outlines osteoporosis assessment and care. For example—the hon. Lady rightly alluded to this —DEXA bone density scanning or FLS are areas that local systems could consider when establishing their hub.

As important as FLS is, it is not the only way in which we can ensure that people with osteoporosis receive the care they need. NHS England’s “Getting it Right First Time” programme has a specific workstream on musculoskeletal health and is exploring how best to support integrated care systems in the diagnosis and treatment of osteoporosis. There is also, alongside that, a range of NICE guidelines to support equity of care for people with osteoporosis, which healthcare professionals and commissioners should absolutely note.

As we know, the economic burden of fragility fractures can be significant. That is why in this year’s spring Budget we announced a package of measures to support individuals at risk of, or experiencing, musculoskeletal conditions to live and work well. Those include: making best use of digital health technologies to support people to better manage symptoms and increase mobility; designing and scaling up MSK community hubs, expanding access to community-based services delivering physical activity interventions; and alongside that, integrating employment advisers into musculoskeletal pathways, building on the success of the NHS talking therapies programme.

Finally, I would like to highlight some of the exciting work that we are supporting on the future of osteoporosis care, and that is about research. Valuable research into MSK conditions such as osteoporosis is being funded by the Department of Health and Social Care, through the National Institute of Health and Care Research. NIHR has awarded £173 million for research into MSK conditions in the last five years. That includes studies into understanding and improving patient experience of diagnosis for vertebral fracture, physiotherapy rehabilitation for osteoporotic vertebral fracture and other treatments for MSK conditions.

In addition, in 2021-22 alone over £30 million has been spent on NIHR infrastructure supported studies and, alongside that, trials into MSK conditions, and six of the NIHR biomedical research centres have MSK conditions as a research theme. NIHR, in collaboration with Versus Arthritis—I referenced earlier some of the fantastic charities working in this space—also funds a dedicated UK musculoskeletal translational research collaboration, which aligns investment in MSK translational research and creates a UK-wide ambition and alongside that a focus to drive cutting-edge research and improve outcomes for patients.

I do not for a second underestimate how painful and debilitating this silent disease is, but I am confident that real advances have been made. I know that we have further to go, but I am confident that, working together, such advances will continue to be made.

This Government are committed to improving the provision of osteoporosis treatment and support. I once again extend my sincere thanks to the hon. Lady for bringing forward this really important debate, and I especially thank the individuals, and indeed the charities and other organisations, who do so much to support people with osteoporosis.

World Arthritis Day

Will Quince Excerpts

Wednesday 25th October 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Ms McDonagh. Let me first congratulate my hon. Friend the Member for Gedling (Tom Randall) on securing a debate on this hugely important issue. I know that he is a tireless campaigner for those living with arthritis, in particular axial spondyloarthritis, and his experience is invaluable in bringing a voice from that community to this place. He made a very emotive and powerful case in his usual articulate and eloquent way. I would also like to thank him for sharing his constituent Elizabeth’s experience, which shows how much further we still have to go in supporting people with this condition.

I would also like to pay tribute to the outstanding charities that support the 10 million people living with arthritis in the UK. I know that my hon. Friend works closely with the National Axial Spondyloarthritis Society—the NASS—and many other charities, such as Versus Arthritis and the National Rheumatoid Arthritis Society, which do such fantastic work to support patients and drive improvements in care. He referenced arthritis week—those charities have collectively made arthritis week a resounding success and do stellar work raising awareness not just during that week, but all year round, as my hon. Friend rightly pointed out.

My hon. Friend is also absolutely right to point to the impact that arthritis has on not only people suffering from the condition, but their families and carers. I know from my own experience of growing up with my grandmother, who lived with rheumatoid arthritis, the impact it had not only on her, but on my mother and the wider family. He is also right to highlight the difference that early diagnosis, the quality of care and proper support can make. He raised a number of important points in this debate; I will turn to each one now.

My hon. Friend made a hugely important point about early diagnosis of the condition and set out some of the challenges. He is right to stress the difference that early diagnosis can make to long-term quality of life. Research from charities shows that one year, rather than eight years, to diagnose inflammatory arthritis can save individuals over £150,000 in lost income and medical expenses. I know that NHS England is working hard to improve early diagnosis rates through its GIRFT—getting it right first time— rheumatology programme, which is designed to improve the diagnosis, treatment and care of patients, but I appreciate and recognise that we have further to go on this. I would be very happy to work with my hon. Friend to see what further improvements we can make alongside NHS England.

In terms of treatments for arthritis, the Government are committed to supporting timely and, vitally, consistent access to effective new medicines for NHS patients with arthritis. The National Institute for Health and Care Excellence has recently recommended several new medicines for arthritis and other rheumatological conditions, including Rinvoq, Tremfya and Skyrizi. These allow patients to benefit from pain reduction and an improved quality of life and are now, I understand, routinely available for clinicians to prescribe to eligible NHS patients in line with NICE recommendations.

My hon. Friend was generous in setting out details about the major conditions strategy, and I agree with so much of what he said. In January of this year, we announced our plan to publish the major conditions strategy, which is designed to tackle the key drivers of ill health in England. We have now published our initial report, “Major conditions strategy: case for change and our strategic framework”, which sets out our plan to promote prevention of non-pharmaceutical interventions. The idea is to create a truly personalised approach for patients. I can assure my hon. Friend that my firm commitment is to continue engaging with charities such as Versus Arthritis and the NASS as we develop that strategy going forward. That is absolutely right; in fact, it is critical that we work with those charities to ensure that we are getting it right as we develop the strategy.

I would also like to touch on gene and cell therapies. In my view, having looked into this not just in relation to arthritis but more broadly, they have huge potential. I am passionate about the UK’s status as a life sciences superpower, and I am really pleased that the Medicines and Healthcare products Regulatory Agency has launched the innovative licensing and access pathway to reduce the time it takes to get innovative medicines to market. In April of this year, the National Institute for Health and Care Excellence recommended Upstaza for aromatic L-amino acid decarboxylase deficiency, which is a horrific genetic disorder affecting children. That is the first gene therapy for children with that condition, which is administered directly into the brain through a minimally invasive procedure.

My hon. Friend touched on elective recovery, and he is right to do so, because we know the size of the waiting list and the impact that has on patients. He rightly raised the waiting times for operations that patients often need, such as joint replacements. Of course, alongside that, it will not have escaped his notice that cutting wait lists is one of the Prime Minister’s five priorities. That is why we are putting record staffing numbers and record levels of funding into our health service. We are spending over £8 billion from 2020 to 2025, plus an additional £5.9 billion specifically for capital projects: funding for new beds; new tech and equipment; community diagnostic centres; and surgical hubs. We have virtually eliminated 18-month waits, and from this month patients waiting over 40 weeks will be informed of their right to be treated somewhere with a shorter waiting list—which of course includes those with arthritis and other musculoskeletal conditions. Patient choice is going to be at the heart of that.

My hon. Friend and I have previously had conversations about prescriptions—particularly free prescriptions—the charges for people with arthritis, and the need to review the current medical exemption list. I believe there has been only one addition to the list since 1968, which was specifically for cancer. I apologise for what may be a disappointing response, but we do not have any plans to make another exemption at this time. However, I would say to my hon. Friend and all those raising this issue that around 89% of prescription items are currently dispensed free of charge, and there are already a wide range of exemptions from prescription charges for those who meet the eligibility criteria.

My hon. Friend has also raised the issue of mental health with me in the past, and we know that about 30% of people with rheumatoid arthritis develop depression within five years of their diagnosis, and that 20% of people with osteoarthritis experience depression or anxiety. Of course, those statistics should concern us. That is why we have made it centrally clear to commissioners at the local level that we expect NHS talking therapies to be integrated into physical healthcare pathways. It is absolutely critical that, alongside their physical health, we also support the mental health of patients. Our NHS long-term plan commits to an additional £2.3 billion a year for the expansion of mental health services by 2024, so that an additional 2 million people can access NHS-funded mental health support.

I hope that my hon. Friend will be reassured by some of the measures that I have outlined today. I recognise that we have to go further, and my hon. Friend made a powerful case for that. To respond to his request for me to work with him, alongside NHS England, to explore how we can do that, my door is of course always open to him and other colleagues on this issue. I would like to thank him again for giving me the opportunity to reiterate our commitment to the very highest standards of care for the 10 million people living with arthritis in this country. I will of course look at what more can be done to address the needs of those affected by arthritis. I will take his points away and give them further thought, so that together we can continue to create the kind of care that patients deserve, to allow them to live their lives to the fullest. I would like to close by again thanking my hon. Friend and the charities for all their work in keeping a spotlight on this issue so that arthritis awareness remains constant in the public eye, not just for one week but every day of the year.

Question put and agreed to.

Future of the NHS

Will Quince Excerpts

Tuesday 24th October 2023 Westminster Hall

[Janet Daby (Lewisham East) (Lab)]

It is an honour to speak with you in the Chair, Mr Pritchard. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing such an important debate.

The NHS was set up in 1948. It was the first of its kind in the western world, leading the way for free medical care—what a great achievement. So many societies still wish that they had what we have.

As has been said by other hon. Members, we have already had 13 years of the Conservatives leading the way—unfortunately with much failure and neglect. We do not have enough doctors or nurses, there are long waiting lists for appointments, and primary care is also not what it should be. People are finding it very difficult to get a GP appointment, there are no NHS dentists, and even pharmacies are really struggling to ensure they have enough medicines to give to people. In addition, mental health services remain the poor relative to the NHS. Under this Government, there has never been enough investment in NHS mental health services.

I will focus my remarks, conversations and questions on the future of the NHS for sickle cell patients. Sickle cell disease is a serious condition which predominantly occurs in people with African and Caribbean backgrounds, and approximately 15,000 to 18,000 people live with it. It has been two years since the “No One’s Listening” report was published by the Sickle Cell Society, which found evidence of serious failings. Failings were found in acute services, and there was evidence of attitudes “underpinned by racism”, meaning that patients were not treated with care. They were ignored, often not believed, and not given the pain relief and oxygen they needed. Unfortunately, we have seen many fatalities because of this.

In January, the NHS Race and Health Observatory found that sickle cell patients undergoing a crisis were deprioritised and undermined. This is in keeping with the “No One’s Listening” report, which presented evidence regarding the death of Evan Nathan Smith in North Middlesex University Hospital in April 2019. The inquest found that Evan’s death would not have happened if it were not for failings in the care that he received. It is shocking every time I say that and every time I mention that.

I have worked with Government Ministers, the NHS and other important bodies to get implemented in full the recommendations that have come out of the “No One’s Listening” report. I ask the Minister to go further and to focus more on those recommendations. If we are looking at the public purse, which has been mentioned a few times in this Chamber, we see that it is more cost-effective to put in preventative measures that help and support people to not get into a crisis where they need to be in hospital.

I therefore ask the Minister: will the NHS develop individual care plans in partnership with the sickle cell patient? Will all NHS trusts require haematology teams to be told when a sickle cell patient accesses outpatient or inpatient care? Will the Minister instruct all integrated care systems to develop plans to provide community care in this area? Will the Minister ensure specialist training opportunities for nurses? Will the Department co-ordinate work between organisations and senior sickle cell service representatives to engage in effective workforce planning for sickle cell services?

If the Minister cannot answer all of those questions towards the end of this debate, I ask him to put it in writing, to do his best, and to also attend the all-party parliamentary group on sickle cell and thalassaemia, which I chair.

[Will Quince]

indicated assent.

[Janet Daby]

The Minister is nodding, so I take that as an indication that he is willing to do that, which is really good. I also implore him to consider that sickle cell is a long-life disease, a hidden disease, a disability, and very serious.

The disease, however, has not had the research funding that it really needs. Looking at people with cystic fibrosis and haemophilia, we that they have had so much more funding invested into medicines to improve the treatment of those illnesses. The National Institute for Health and Care Research funds research programmes, but sickle cell research is woefully inadequate compared with the diseases that I have already mentioned. According to the data produced by that organisation, approximately 18,000 people are living with sickle cell, compared with the 10,000 that are living with cystic fibrosis, but in 2017-18 over a million pounds more was spent on research for cystic fibrosis. In the present day, 2022-23, still over a million pounds more is being spent on research for cystic fibrosis compared with sickle cell. That is entirely unacceptable, especially when there are more people living with sickle cell. I do not wish to take away funding from other research, but I do want equality of funding. I am sure the Minister also wants this as well.

As I draw to a close, I have already mentioned that prevention has to be the ultimate way to help people live a good quality of life and to keep them out of hospital, and it also helps to take of care of the public purse. In conclusion, the NHS is a wonderful creation that has helped every single person in this Chamber, and indeed every single person in our country.

--- Later in debate ---

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a debate on this important matter. A debate of this nature is almost impossible to respond to in a relatively short period of time—although it is slightly longer now. I could easily fill the 90 minutes on the future of the NHS, as I know could all hon. Members across the Chamber today. I will endeavour to respond to as many of the issues and themes raised as possible in the time left available to me and, if I can, before the Front Benchers in the main Chamber conclude and we are all summoned over to vote.

While we will not always agree on the best approach—in fact, I strongly disagree with so much of what the hon. Lady said in her opening speech—I can assure her and Members across the House that I share her passionate desire to see an NHS that delivers and continues to deliver excellent care to all its patients, both now and in the future. Similarly to the Opposition Front-Bench team, the Government believe that the NHS should be free at the point of delivery and that its offer should be comprehensive, with services provided based solely on need. Let me absolutely clear: that will never change. In response to the themes raised in the debate, I will start by focusing on three broad areas: funding, workforce, and finally transformation and innovation.

Turning first to funding, as my hon. Friends the Members for Shrewsbury and Atcham (Daniel Kawczynski) and for Southend West (Anna Firth) set out, we have invested record amounts in the future of our healthcare system. By the end of this Parliament, core spending will have increased from £140.5 billion in 2019-20 to £193 billion in 2024-25. For those good at maths, that is a cash increase of £52.6 billion or 37%. At the beginning of this debate, several of us got a little excitable when the issue of privatisation was raised, and you rightly shut us down, Mr Pritchard. People have managed to make their contributions, but this is perennial accusation levelled at the Government, so let me absolutely clear: it is not our policy and it is not our plan. The NHS is not, and never will be, for sale.

Look at the actual facts on this. In 2013-14, around 6.1% of NHS funding was spent on the independent sector. Now let us jump to 2021-22, when it was 5.9%. What we are doing, however, is using the independent sector to enable us to fully realise our healthcare system’s capacity, and of course to improve performance. This is an approach that I understand is supported by the shadow Secretary of State for Health, the hon. Member for Ilford North (Wes Streeting). It is an approach that is better for patients and for our NHS. We are giving our patients greater choice and control, and empowering them to shape and manage their own healthcare.

[Daniel Kawczynski]

I am very grateful to my hon. Friend for highlighting the extraordinary increases in Government funding for the NHS, but has he recognised during the course of this debate my concern that, seven years after securing the £312 million for modernisation of A&E services in Shropshire, not a single brick has been laid? How sustainable is this NHS model when the managers of our local trusts are so incapable of delivering the construction with what we have secured for them?

[Will Quince]

I hear my hon. Friend’s concern. I have met with him and other Shropshire MPs on this issue and committed to meet with him to discuss it again. We are very keen to resolve the situation.

Before I move on from privatisation, let me gently say to Opposition Members—some of whom raised it and some of whom did not—that patient choice and the ability to use the private sector has been part of the NHS since its formation. It is a fundamental part of the NHS constitution. Let us be clear what those who call for private sector involvement to be entirely removed from the NHS are calling for: they are calling for charities, independent sector providers, GPs, dentists and community pharmacies to be removed. So let us be very careful, and very clear about exactly what we are calling for, because the independent sector plays an important role.

[Margaret Greenwood]

While the Minister is on the subject of privatisation, I would like him to respond to two points. First, the Health and Social Care Act 2012 allowed NHS foundation trusts to earn 49% of their money from private patients. Can he explain how that benefits ordinary patients? Clearly, if half a hospital is given over to private patients, the waiting time doubles. Secondly, representatives of private companies sit on integrated care partnerships, which are responsible for preparing the integrated care strategy for an area. How can it be right that a private company can influence how a huge amount of public money is spent?

[Will Quince]

I thank the hon. Lady for her question. I have already committed to write to her on some of the points relating to the 2012 Act, because she raised a number of questions. On the broader point about whether the independent sector should be part of integrated care boards and partnerships, I think it is helpful if it is, because individual systems need to know the full capacity available to them, and that includes the independent sector, which plays an important role because it is part of the health ecosystem in an area.

[Margaret Greenwood]

rose—

[Will Quince]

I will come back to the hon. Lady, but I am conscious of time.

The second area widely covered today was workforce. I echo the hon. Lady’s thanks to our NHS staff. I want to put on record my personal thanks to all those working in our health and care system: doctors, nurses, allied health professionals, managers, carers—all those who work in our NHS—for their hard work and dedication. We remain deeply grateful to them for all their work during the pandemic, in facing the new challenges of tackling the backlog, and of course the routinely excellent care they provide day in, day out. Our long-term workforce plan embodies the Government’s commitment to NHS sustainability: we are funding more doctors, more nurses and healthcare workers employed on NHS terms and conditions by NHS providers. That is backed by an additional £2.4 billion over the next five years, and at the heart of it is a significant increase in training places.

The third theme I want to focus on is transformation and innovation, which has also been touched on. We are committed to making our NHS more integrated, more strategic and better able to tackle the challenges it faces. The hon. Lady referenced the Health and Care Act 2022 numerous times—I hear her questions and points, and I will write to her on them. We put those issues on a statutory footing. We know that an increasing number of people are living with chronic medical conditions and complex care needs, which is where more integrated services can and will make an enormous difference. We want partners focusing on improving services rather than competing with each other when it is not in the interest of patients. I believe—we believe—that is the right approach because local areas know best, and certainly know far better than Ministers in Whitehall how best to organise themselves and design and deliver the best possible care for patients.

[Ian Lavery]

Will the Minister give way?

[Will Quince]

I have to make some progress—I am conscious of time.

In addition, we have digital transformation and technology, which are critical to the future of the health and social care system. Embracing digital provides a significant opportunity for us to improve clinical service to deliver better care for patients and reduce pressures on the NHS. That is why we are investing around £1.5 billion a year in digital transformation to run live services and drive those transformation ambitions. That also includes plans to improve our NHS app, digitise the frontline and improve services. We are also working with trusts to deliver things such as electronic discharge and electronic bed management systems, which also improve efficiency within the NHS.

The hon. Member for Lewisham East (Janet Daby) mentioned NIHR research, which I want to touch on briefly. We spend around £1 billion a year on that, but the Government do not commission research directly; indeed, it would be totally wrong for any Minister or shadow Minister to direct our clinicians and researchers to look into a particular area. However, we encourage and rely on organisations to come forward with bids for research, which clinicians then look at. That is rightly independent from Government, and I will be happy to work with the hon. Member to see how we can get more research into that area.

I wanted to say so much more, but time is short and I want to ensure that the hon. Member for Wirral West has time to respond. The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) touched on the life sciences space. We are putting a huge amount of work into life sciences with the Life Sciences Council and the life sciences vision, and we have launched the dementia, mental health, cancer, obesity and addiction missions, with more than £210 million in Government investment and world-leading chairs to support them. There is also our additional investment in genomic medicine, which the hon. Member rightly touched on and which is a hugely exciting field. The ability to screen for and identify the prevalence of future disease and the ability to screen babies in future will be hugely exciting. This is definitely the future of medicine.

This is a hugely important debate and I have far more to say, as you can tell, Mr Pritchard. The NHS is a vital part of the fabric of our public life. It is beloved by the public and rightly held in the highest esteem. The Government believes in the NHS; I believe in the NHS. That is why we are taking the right long-term decisions to protect its future.

[Mark Pritchard (in the Chair)]

Margaret Greenwood to wind up. The Minister has very generously given the hon. Member three rather than two minutes.

Childhood Cancer Outcomes

Will Quince Excerpts

Tuesday 17th October 2023 Commons Chamber

[The Minister for Health and Secondary Care (Will Quince)]

I thank the hon. Member for South Shields (Mrs Lewell-Buck) for securing this important debate. I begin by sending my sincerest support and sympathy to Ethan’s family and every family involved in the work of Alice’s Arc. Their mission to find a cure and kinder treatment for rhabdomyosarcoma is one that I am sure the whole House can support.

As the hon. Lady rightly mentioned, September was Childhood Cancer Awareness Month, and I think I speak for the whole House when I say that our thoughts are with every family touched by childhood cancer, particularly those who have felt the bitter grief of losing a child. I commend the efforts of so many to bring light to the darkest of situations and support families in need, including the hon. Lady, who made such a powerful and emotive speech. I also join her in paying tribute to my hon. Friend the Member for Gosport (Dame Caroline Dinenage) for her tireless efforts to improve childhood cancer care.

I want to assure the House and all families affected that cancer services for children are an absolute priority for this Government. Working alongside the NHS, we have three priorities to improve childhood cancer outcomes: improving early diagnosis, delivering more research and driving progress in genomic medicine. Let me take each one in turn.

First, improving early diagnosis will give more children the best chance of beating cancer. The NHS is working to deliver the ambition it set in its long-term plan to diagnose 75% of cancers at stages 1 and 2 by 2028. Achieving that will mean 55,000 more people surviving cancer for five years or more. That is why the Government are investing more than £2.3 billion to transform diagnostics services. Thanks to that investment, we have opened 123 new community diagnostic centres, giving millions of patients the chance to access quicker, more convenient checks outside of hospitals, and we are on track to open 160 CDCs by March 2025.

In this year’s operational planning guidance, NHS England announced £390 million of funding to cancer alliances in each of the next two years to support the operational priorities for cancer treatment capacity. That includes commissioning key services in early diagnosis and supporting systems to develop local cancer plans. We are now expanding direct access to diagnostic scans across all GP practices, helping GPs to recognise cancer symptoms, cutting waiting times and speeding up diagnosis.

Secondly, as the hon. Member for South Shields rightly pointed out, delivering more research is key to understanding the causes of cancer and increasing survival rates further. Over the past five years, the National Institute for Health and Care Research has invested almost £14 million in 38 research projects into childhood cancers. Alongside Cancer Research UK, health Departments across the UK are jointly funding a network of 18 experimental cancer medicine centres, collectively investing more than £35 million between 2017 and 2022.

Our world-leading scientists and clinicians are driving the discovery, development and testing of new treatments. That includes the paediatric network that the National Institute for Health and Care Research co-funds with the Little Princess Trust, which is dedicated to early-phase research on childhood cancers. NHS children’s cancer services are provided by highly specialist principal treatment centres that manage care through multidisciplinary teams across diagnosis, treatment and research, making research breakthroughs available to every child.

Turning to our work to drive progress in genomic medicine, the UK is a world leader in that sector, and cutting-edge research already benefits children with cancer. However, the Government are committed to going further: our priority is ensuring that all children with cancer get access to genomic medicine. The NHS now offers all children with cancer whole-genome sequencing to enable comprehensive and precise diagnosis, along with personalised treatments. In July this year, the Government announced a multi-year partnership agreement with the pharmaceutical giant BioNTech, which will accelerate that company’s clinical trials here in the UK and could provide up to 10,000 patients with personalised cancer immunotherapies by 2030. It will work with NHS England’s new cancer vaccine launchpad to improve access to treatments and trials. This Government will continue to support groundbreaking genomic medicine to give children with cancer the high-quality personalised treatments they deserve.

Children with cancer also deserve a supportive experience in hospital, as do their families. That is why I am pleased that NHS England is working with the Starlight Children’s Foundation charity to review and improve play facilities and guidance to hospital trusts, and we will learn from the first under-16 cancer patient experience survey. More than three quarters of children with cancer said they are looked after very well by healthcare staff, and almost 90% of parents or carers rated the care their child received as eight or more out of 10. That shows what our brilliant cancer workforce does so well, and also where we have more work to do.

Once again, I thank the hon. Member for South Shields for tabling this vitally important debate.

[Mrs Lewell-Buck]

I sense that the Minister is coming to the end of his comments. I have listened carefully to him, but he has largely referred to funding and research into cancers overall. He knows full well that childhood cancers are distinct from adult cancer, so could he offer us any clarity on how much money goes into childhood cancer research, and what the workforce plan is for those specialists working in paediatric cancer?

[Will Quince]

I am very happy to take both those questions. First, in relation to childhood cancer research specifically, my officials in the Department are working really closely with the National Institute for Health and Care Research to set up an expert roundtable on childhood cancer research. Many trials will be applicable to both adults and children, but by their nature, some will need to be childhood cancer-specific. I welcome that important initiative, which is designed to encourage more research into cancers affecting children.

The Government do not, in effect, commission research directly. Bids are made to NIHR; around £1 billion a year is spent directly on research through NIHR, but it is reliant on those bids. That is why it is so important that we get more bids for research into childhood cancer coming forward.

[Jim Shannon]

I thank the Minister for his response and also for his clear understanding of the issue. We appreciate his words. On Saturday past, we had our party conference. There were a number of stalls, including for a cancer charity. It has a charter, and at the top of that was a target that 70% of those who have cancer will survive and heal. Can the Minister indicate whether he and his Department have the same ambition to secure 70% of people with cancer surviving and being cured, especially children?

[Will Quince]

Where I very much agree with my hon. Friend is that research is so much at the heart of this matter. The hon. Member for South Shields asked specifically how much funding is going directly into childhood cancer research, and my understanding is that over the past five years, the National Institute for Health and Care Research specifically has funded 38 projects relating to childhood cancers and has spent just under £14 million on research specifically into childhood cancers. She is absolutely right that children’s cancer risk factors are not very well understood, as this group of cancers is rare and diverse—I think it makes up around 1% of all cancers. That is why the expert roundtable on childhood cancer research is so important, and I will continue to consider with colleagues across the House what more we can do on this important matter to get more bids for funding specifically for research into childhood cancers to come forward.

A handful of months ago, the Government published the NHS long-term workforce plan. Although it does not go into specific detail on speciality or cancer services, we are working closely with cancer charities and others to determine what the requirement would be going forward. To ensure that we get it right, I would be happy to meet the hon. Lady and any others with an interest in this area to feed into the team looking at implementation of the NHS long-term workforce plan.

I again thank the hon. Lady for tabling this vital debate, and I thank all Members who have contributed today. Families who have been affected by childhood cancer have a right to know that the Government and everyone across this House stand with them. I assure the House that improving childhood cancer outcomes is a top priority for this Government and for me personally. I will continue to work with the NHS to ensure faster diagnosis, further and broader research and greater access to groundbreaking treatment. I assure you, Mr Deputy Speaker, and the House that we will leave no stone unturned in our mission to beat cancer.

Question put and agreed to.